1973 Volume 70 Issue 4 Pages 369-377
Transthoracic esophageal transection was performed in a total of 23 cases of portal hypertension with esophageal varices, i.e., 12 cases of cirrhosis, 4 cases of intrahepatic portal obstruction, and 7 cases of extrahepatic portal obstruction.
There were 5 postoperative deaths, in most of which the emergency operations were underwent under the severe hepatic dysfunction with advanced cirrhosis. The hepatic function test revealed the extremely high values of glutamic oxalacetic transaminase and bromsulfalein retention compared with these in survivors where no noticeable changes in hepatic function were demonstrated.
Esophageal varices were disappeared in 16 cases of 18 ones (88%) with conspicuous improvement in other two cases. The late outcome of the patients which survived more than 6 months after the operation showed appreciable disappearance of the esophageal varices. Besides, no variation in hepatic function test was exhibited. All the patients were adjusted better to normal life than preoperatively. Moreover, in only one case with recurrent varices it was fairly dispapeared after the second stage operation of splenectomy and ligation of the coronary vein.
It can be seen that esophageal transection is to be indicated primarily as an emergency operation for the bleeding esophageal varices because of both its effectiveness of protection against for the further hemorrhage and its minor surgical interventions. The effectiveness was enhanced by performing splenectomy and ligation of the coronary vein together with the transection, however, these procedures should be done secondarily for the patients with poor risk as advanced cirrhosis or the emergency cases.